scholarly journals Recurrent Hemispheric Stroke Syndromes in Symptomatic Atherosclerotic Internal Carotid Artery Occlusions: The Carotid Occlusion Surgery Study Randomized Trial

Neurosurgery ◽  
2019 ◽  
Vol 87 (1) ◽  
pp. 137-141 ◽  
Author(s):  
Fadi Nahab ◽  
Michael Liu ◽  
Haseeb A Rahman ◽  
Srikant Rangaraju ◽  
Daniel Barrow ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Occlusion ◽  
Hemispheric Stroke ◽  
Significant Difference ◽  
Baseline Characteristics

ABSTRACT BACKGROUND There are limited data on outcomes of extracranial-intracranial (EC-IC) bypass in patients with recurrent hemispheric syndromes due to atherosclerotic internal carotid artery occlusion (AICAO). OBJECTIVE To compare clinical outcomes and efficacy of EC-IC bypass surgery in patients with and without recurrent hemispheric syndromes associated with AICAO in the Carotid Occlusion Surgery Study (COSS). METHODS In patients enrolled in the COSS trial, we compared baseline characteristics and clinical outcomes for participants with (rHEMI+) and without recurrent hemispheric ischemia (rHEMI−) prior to randomization into surgical vs medical groups. The primary outcome was all stroke and death from randomization through 30 d and ipsilateral ischemic stroke within 2 yr. RESULTS Of 195 randomized participants, 100 were rHEMI+ (50 in each group). Baseline characteristics between rHEMI+ and rHEMI− participants were similar except rHEMI+ were more likely to have had previous stroke prior to randomization (61% vs 20%, P < .01) and to have TIA as the entry event (59% vs 21%, P < .01). All primary endpoints were ipsilateral ischemic strokes. There were no significant differences in occurrence of the primary endpoint between nonsurgical and surgical participants in rHEMI+ (26.3% vs 22.4%, P = .660) and rHEMI− (18.9% vs 19.5%, P = .943). For nonsurgical participants, there was no significant difference in the primary endpoint for rHEMI+ vs rHEMI− patients (P = .410) CONCLUSION Patients with recurrent hemispheric stroke syndromes enrolled in the COSS trial did not show benefit from EC-IC bypass compared to medical treatment. Early aggressive risk factor measures should be prioritized to reduce recurrent strokes in these patients.

scholarly journals Ekstrakranijinės-intrakranijinės jungties operacijos galimybės ir dažnis ištikus išeminiam insultui miego arterijos baseine

2003 ◽  
Vol 1 (2) ◽  
pp. 0-0
Author(s):  
Kęstutis Laurikėnas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Stroke Patients ◽  
Hemispheric Stroke ◽  
Preoperative Selection

Kęstutis LaurikėnasVilniaus universiteto Neuroangiochirurgijos centras,Vilniaus greitosios pagalbos universitetinės ligoninėsKraujagyslių chirurgijos skyrius,Šiltnamių g. 29, LT-2043 VilniusEl paštas: [email protected] Įvadas / tikslas Šiuo metu pasaulinėje medicinos literatūroje raginama atlikti naujus ekstrakranijinės-intrakranijinės jungties operacijų veiksmingumo tyrimus, siekiant nurodyti aiškesnes šių operacijų indikacijas. Darbo tikslas buvo išsiaiškinti, kokiai daliai ligonių, sergančių išeminiais galvos smegenų sutrikimais, instrumentinių tyrimų būdu randama užakusi vidinė miego arterija arba susiaurėjusi a. cerebri media, ir kokiam šių ligonių skaičiui įmanoma atlikti ekstrakranijinės-intrakranijinės jungties operaciją. Ligoniai ir metodai 2000 metais VGPUL gydyta 418 ligonių, kuriems buvo išeminis kraujotakos sutrikimas miego arterijos baseine. Po detalaus klinikinio ir instrumentinio ištyrimo operuoti 95 ligoniai (23 % visų neembolinio tipo išeminių kraujotakos sutrikimų miego arterijos baseine). Rezultatai Hipoperfuzinio tipo išeminis insultas miego arterijos baseine ištiko 25 % ligonių iš visų 1677 smegenų kraujotakos nepakankamumu sergančių ligonių, gydytų stacionare. Iš 418 ligonių 385 (92 %) diagnozuotas išeminis insultas ir tik 33 ligoniams (8 %) – praeinantys kraujotakos sutrikimai miego arterijos baseine. Iš 418 ligonių chirurginis gydymas taikytas 95 (23 %) ligoniams. Tačiau patomorfologiniai miego arterijos ir jos šakų pokyčiai rasti net 183 (44 %) ligoniams iš 418, sergančių kraujotakos sutrikimais miego arterijos baseine. Ekstrakranijinės-intrakranijinės jungties operacija atlikta 12 ligonių (12,6 % visų miego arterijos rekonstrukcinių operacijų), iš jų 7 ligoniams miego arterija buvo užakusi kakle, 5 ligoniams diagnozuotas a. cerebri media užakimas arba kritinė stenozė, be to, 9 ligoniai sirgo išeminiu insultu ir 3 ligoniams buvo praeinantys kraujotakos sutrikimai (TIA). Išvados Dauguma ligonių, kuriems yra praeinantys išeminiai kraujotakos sutrikimai miego arterijos baseine, yra gydomi ambulatoriškai, reikiamai neištiriami arba iš viso liga nediagnozuojama. Todėl galima teigti, jog Lietuvoje miego arterijos patologija yra užleista. Prasminiai žodžiai: ekstrakranijinė-intrakranijinė jungtis, išeminis insultas, miego arterijos užakimas, chirurginis gydymas. Extracranial-intracranial bypass operations in cases of ishemic events of the brain Kęstutis Laurikėnas Background Surgical correction of insuffitient collateral circulation in cases of internal carotid artery occlusion first was postulated in 1951 by C. M. Fisher. The operative technique of M. G. Yasargil, using the superficial temporal artery as a bypass, is now the most successful surgical operation for cerebral revascularisation. The establishment of extra-intracranial arterial bypass surgery is based on the fact that nature itself in cases of stenosis or occlusion of internal carotid artery creates such a bypass, usually using the ophthalmic artery. But sometimes the patients could benefit from extra-intracranial bypass operation. Our retrospective study discovered a good number of neurologically successful extra-intracranial operations which have been performed in a large number of stroke patients. Results In the Vilnius Emergency Hospital we treated 418 patients with hemispheric stroke (with carotid or middle cerebral artery stenosis or occlusions). Neurologically deteriorated patients with large ischemic changes on CT were treated conservatively. After CT, TCD, Duplex and angiographic investigations we performed 83 carotid endarterectomies (20% of all patients) and only 12 extracranial-intracranial bypasses (3% of all patients) with good postoperative outcomes. Conclusions Good postoperative results were obtained only after a meticulous clinical preoperative selection of stroke patients. Extra-intracranial bypass was suitable in only about 3 per cent of nonembolic hemispheric stroke patients. Keywords: extracranial-intracranial bypass, carotid artery occlusion, stroke, surgical treatment

scholarly journals Successful Bridging Therapy in a 103-Year-Old Woman with Acute Terminal Internal Carotid Artery Occlusion

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 9-14
Author(s):  
Trung Quoc Nguyen ◽  
Hoang Thi Phan ◽  
Tinh Quang Dang ◽  
Vu Thanh Tran ◽  
Thang Huy Nguyen
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Left Internal Carotid Artery ◽  
Bridging Therapy ◽  
Nihss Score ◽  
Current Guidelines

The efficacy of intravenous thrombolysis and endovascular therapy and their favorable treatment outcomes have been established in clinical trials irrespective of age. Current guidelines do not recommend an age limit in selecting eligible patients for reperfusion treatment as long as other criteria are satisfied. A 103-year-old woman was admitted at our hospital within 1 h of stroke onset secondary to a left internal carotid artery terminus occlusion. On admission, her National Institutes of Health Stroke Scale (NIHSS) score was 30, with a small left thalamic diffusion restriction lesion on MRI. Her medical history included paroxysmal atrial fibrillation, prior myocardial infarction, hypertension, chronic kidney disease, and diabetes mellitus. Her pre-stroke modified Rankin Scale score was 0, and she was fully independent before stroke. Once intravenous thrombolysis was started, the patient successfully underwent mechanical thrombectomy, and thrombolysis in cerebral infarction-3 recanalization was achieved 225 min after symptom onset. She showed dramatic recovery (NIHSS score of 5 after 48 h) and was discharged on day 7 with a modified Rankin Score of 1. To our knowledge, our patient is the second oldest documented patient who successfully underwent bridging therapy for stroke.

scholarly journals Brain Temperature Measured by Magnetic Resonance Spectroscopy to Predict Clinical Outcome in Patients with Infarction

Sensors ◽  
2021 ◽  
Vol 21 (2) ◽  
pp. 490
Author(s):  
Tomohisa Ishida ◽  
Takashi Inoue ◽  
Tomoo Inoue ◽  
Toshiki Endo ◽  
Miki Fujimura ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Mr Spectroscopy ◽  
Internal Carotid ◽  
Brain Temperature ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Clinical Settings ◽  
Brain Swelling

Acute ischemic stroke is characterized by dynamic changes in metabolism and hemodynamics, which can affect brain temperature. We used proton magnetic resonance (MR) spectroscopy under everyday clinical settings to measure brain temperature in seven patients with internal carotid artery occlusion to explore the relationship between lesion temperature and clinical course. Regions of interest were selected in the infarct area and the corresponding contralateral region. Single-voxel MR spectroscopy was performed using the following parameters: 2000-ms repetition time, 144-ms echo time, and 128 excitations. Brain temperature was calculated from the chemical shift between water and N-acetyl aspartate, choline-containing compounds, or creatine phosphate. Within 48 h of onset, compared with the contralateral region temperature, brain temperature in the ischemic lesion was lower in five patients and higher in two patients. Severe brain swelling occurred subsequently in three of the five patients with lower lesion temperatures, but in neither of the two patients with higher lesion temperatures. The use of proton MR spectroscopy to measure brain temperature in patients with internal carotid artery occlusion may predict brain swelling and subsequent motor deficits, allowing for more effective early surgical intervention. Moreover, our methodology allows for MR spectroscopy to be used in everyday clinical settings.

Progressive Hydrocephalus as a Complication of Cervical Internal Carotid Artery Occlusion in a 4-Year-Old Child

Neurosurgery ◽  
1981 ◽  
Vol 8 (4) ◽  
pp. 466-468
Author(s):  
Richard J. Lister ◽  
John K. Vries
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Diagnosis And Management ◽  
Computed Tomographic ◽  
Cervical Internal Carotid Artery

Abstract A case of progressive hydrocephalus as a complication of spontaneous cervical internal carotid artery occlusion in a child is presented. This problem has not been reported previously. The diagnosis and management of this condition are greatly facilitated by computed tomographic scanning.

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